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Consistent Weight Loss
September 2000

Q. I am a 35-year-old woman, wife and mother of two children. I weigh 96 pounds. I've lost my sex drive and have lost an average of 1 pound per year since the birth of my first child. I eat normal meals. I have never tried to diet. I have been to my gynecologist, endocrinologist and now he is referring me to an internist. My metabolic workup came back normal. I am desperate to gain weight because I believe that my weight and how I look is affecting my ability to perform sexually. If the internist does not find anything physically wrong with me, where do I go next? Could I have an eating disorder and not know it? Any help would be greatly appreciated and if you could recommend any eating disorder clinics in case that might be my next alternative in finding out what is wrong with me, it would be greatly appreciated.

A. There are several causes for weight loss. Both physical (biologic) and psychological factors are very important in weight maintenance. Various metabolic disorders such as hyperthyroidism (over-active thyroid gland), and Diabetes (high blood sugar), as well as Cancer are just some of the many causes of weight loss. Depression is probably the most common psychological cause of weight loss. Also, it is possible to have an eating disorder and not realize it. Anorexia Nervosa is a condition characterized by a distorted body image, where one looks in the mirror and sees themselves as being fat/overweight even though to other people, they look thin. This often leads to malnutrition and diuretic abuse which can lead to serious adverse complications such as premature osteoporosis and even heart arrhythmia's and death due to low potassium.

It sounds like you are doing the appropriate steps in evaluation having seen your gynecologist and endocrinologist already. I believe it is reasonable to get an internists opinion. If he/she does not find a cause for the weight loss, I believe that a psychiatric consultation would be very important. From there, if the psychiatrist suspects an eating disorder, they can refer you to the appropriate eating disorder specialist in your area. The medication Prozac can be very helpful in conjunction with counseling.

For now, do the best you can with eating regular well balanced meals. Consider some supplements such as Ensure, 1 can two to three times per day. Also, I would be sure to take a Multivitamin such as Theragran M, one per day, Elemental Calcium 500mg one tab two to three times per day and Vitamin E 400 IU per day.

Good Luck.

Reference:

  • Harrison's text of internal medicine.

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